On-site visits

DHS will conduct on-site visits at settings presumed not to be home and community-based (defined below) to gather evidence to show compliance:

Prong 1 settings: Located in a hospital, nursing facility, intermediate care facility (ICF-DD) or institution for mental disease (IMD).
Prong 2 settings: Located adjacent to a public hospital, nursing facility, ICF-DD or IMD.
Prong 3 settings: Have the effect of isolating people from the broader community of people who do not receive HCBS.

DHS plans to conduct site visits to Prong 1 and Prong 2 settings through the end of 2019. DHS plans to begin site visits to Prong 3 settings in fall 2018. A list of providers that meet these criteria can be found under the Settings to be visited tab.

Note: Find the criteria to identify settings located in and adjacent to institutions under the Resources tab.

During the on-site visits, HCBS providers will be able to show that their operations and programs are separate from the institutions. We will include the information we gather at on-site visits in the information that we send to CMS for heightened-scrutiny assessments (evidentiary packages). We expect settings that are presumed not to be HCBS to meet the HCBS Final Rule requirements.

What to expect
Settings to be visited
Evidentiary packages
Resources

What to expect

DHS staff will conduct the on-site visit for each setting. We expect the visit to last two to three hours. We will schedule the visit by coordinating with the administrator/owner or his or her designee to ensure appropriate staff and people who receive services are available during the visit.

During the site visit, DHS will:
- Observe and assess the setting based on the CMS guidance document, Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information (PDF).
- Interview the administrator of the program or his or her designee, staff and people who receive services.
- Hold a brief exit meeting to discuss the following next steps with the provider:
1. Development of the setting’s evidentiary package
2. Public input
3. Submission of evidentiary package to CMS for heightened scrutiny
4. CMS final determination
5. Notification of heightened scrutiny final determination
Settings to be visited
- Prong 1 and Prong 2
- Prong 3: Coming soon
If the information in the on-site visit list is inaccurate, use the DSD contact form to contact us. Please include the name of the setting, the license number of your setting for proper identification and the reason the setting should not be on the list.
Evidentiary packages

The Centers for Medicare & Medicaid Services (CMS) requires states to submit evidentiary packages for home and community-based settings that they presumed are not home and community based. Evidentiary packages include information gathered during on-site visits and the provider-attestation process. CMS will conduct heightened-scrutiny assessments for settings that meet the following criteria:
- Prong 1 settings: Located in a hospital, nursing facility, intermediate care facility (ICF-DD) or institution for mental disease (IMD).
- Prong 2 settings: Located adjacent to a public hospital, nursing facility, ICF-DD or IMD.
- Prong 3 settings: Have the effect of isolating people from the broader community of people who do not receive HCBS.
See the HCBS settings evidentiary packages webpage for more information and links to the evidentiary packages.

For more information about the heightened-scrutiny process, see the CMS guidance document, Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information (PDF).
Resources